Evaluation of Tobacco Treatment Strategies for Inpatient Psychiatry

住院精神病学烟草治疗策略的评估

• 批准号: 8040918
• 负责人: Judith J. Prochaska
• 金额: $ 60.24万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2014-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8040918
• 关键词: Abstinence; Accounting; Acute; Address; Adopted; Adult; Alcohols; American Psychiatric Association; Area; Behavioral; Budgets; Cardiovascular Diseases; Cigarette; Clinical Treatment; Cognitive; Community Hospitals; Computers; Counseling; Disease; Drug usage; Effectiveness; Evaluation; Future; Goals; Guidelines; Health; High Prevalence; Hospitalization; Illicit Drugs; Individual; Inpatients; K-Series Research Career Programs; Life; Lung diseases; Malignant Neoplasms; Manuals; Mediator of activation protein; Medical; Mental Health; Mental disorders; Mentors; Modeling; Nicotine Dependence; Participant; Patients; Persons; Physiological; Professional counselor; Psychiatric Hospitals; Psychiatry; Publishing; Randomized Clinical Trials; Randomized Controlled Trials; Readiness; Recruitment Activity; Reporting; Research; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Staging; Substance abuse problem; Symptoms; Time; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Treatment outcome; Withholding Treatment; base; brief intervention; cost; cost effectiveness; design; evidence base; follow-up; individualized feedback; multi-component intervention; nicotine replacement; patient population; public health relevance; severe mental illness; smoke-free policy; smoking cessation; success; treatment as usual; treatment strategy

DESCRIPTION (provided by applicant): The overall goal of this research is to identify efficacious strategies for treating tobacco dependence among adult smokers hospitalized with severe mental illness. Nicotine dependence is the most prevalent substance abuse disorder among psychiatric patients, a group that accounts for a staggering 44% to 46% of the US tobacco market16, 17. In terms of dollars spent, this equates to $39 billion in annual tobacco sales18. While numerous trials have established the effectiveness of smoking cessation interventions for hospitalized medical patients, little research has targeted the acute psychiatric inpatient setting19. The American Psychiatric Association's tobacco treatment guidelines identify psychiatric hospitalization as an ideal opportunity for promoting smoking cessation1. Individuals with mental illness have lower quit rates and may be less motivated and prepared to quit in the near future than the general population20-22. Thus, sufficiently intense, multi- component interventions are needed that address both the physiological and behavioral aspects of nicotine dependence and assist smokers at all stages of readiness through the quitting process23. Using a three group additive design, the proposed randomized clinical trial (N=1100) aims to evaluate tobacco cessation treatments of varying intensities initiated in the acute psychiatric inpatient setting. The application builds upon Dr. Prochaska's K23 mentored career development award and seeks to determine: (i) whether the initial successes seen in an academic-based psychiatric hospital can be replicated in a larger and more diverse patient population recruited from a community hospital; and (ii) if more extended and intensive clinician-delivered treatment can outperform our current best practices. The three groups are: (1) Usual Care (N=150) consisting of brief cessation advice, a quit smoking guide, and nicotine replacement provided during hospitalization; (2) Brief Treatment (N=475) adds a stage-based manual, computer-delivered stage-tailored individualized feedback and brief cessation counseling sessions during hospitalization and repeated at months 3 and 6, and access to 12 weeks of nicotine replacement following hospitalization; (3) Extended Treatment (N=475) builds upon our current brief treatment and provides 12 additional weeks of nicotine replacement (24 weeks total) with individualized, counselor-delivered motivational and manualized cognitive behavioral cessation treatment. We hypothesize that the extended treatment will outperform the brief treatment, and that both treatment groups will be more effective than usual care in producing quit attempts and ultimately abstinence from cigarettes. Secondary aims will model the cost-effectiveness of the treatment conditions; examine moderators and mediators of treatment outcomes; and prospectively examine the relation between changes in smoking, mental health functioning, and use of other substances over time. Public Health Relevance Statement: Individuals with mental illness in the US are dying, on average, 25 years prematurely, with tobacco-related illnesses of cardiovascular and lung disease and cancer identified as chief causes24. Despite the high prevalence of smoking, low rates of quitting, and devastating health effects, clinical treatment research with smokers with mental illness remains limited. This study aims to evaluate, in a randomized controlled trial, tobacco treatments of varying intensities for smokers hospitalized on acute psychiatric inpatient units in a community hospital.

描述（由申请人提供）：本研究的总体目标是确定治疗严重精神疾病住院的成年吸烟者烟草依赖的有效策略。尼古丁依赖是精神病患者中最普遍的物质滥用障碍，这一群体占美国烟草市场的44%至46%。就花费的美元而言，这相当于每年烟草销售额390亿美元18。虽然许多试验已经确定了戒烟干预措施对住院患者的有效性，但很少有研究针对急性精神病住院患者19。美国精神病学协会的烟草治疗指南将精神病住院视为促进戒烟的理想机会1。与普通人群相比，精神疾病患者的戒烟率较低，在不久的将来戒烟的动机和准备可能较低20 -22。因此，需要足够强烈的多组分干预，以解决尼古丁依赖的生理和行为方面，并在戒烟过程的所有准备阶段帮助吸烟者23。使用三组加法设计，拟议的随机临床试验（N=1100）的目的是评估不同强度的戒烟治疗开始在急性精神病住院设置。Prochaska的K23指导职业发展奖，并试图确定：（i）是否可以在一个更大，更多样化的患者群体从社区医院招募的学术为基础的精神病医院看到的初步成功复制;和（ii）如果更广泛和更密集的临床医生提供的治疗可以超越我们目前的最佳实践。这三组是：（1）住院治疗（N=150），包括简短的戒烟建议、戒烟指南和住院期间提供的尼古丁替代品;（2）简短治疗（N=475）在住院期间增加了基于阶段的手动、计算机交付的阶段定制的个性化反馈和简短的戒烟咨询课程，并在第3个月和第6个月重复，并在住院后获得12周的尼古丁替代治疗;（3）扩展治疗（N=475）建立在我们目前的短期治疗基础上，并提供额外12周的尼古丁替代治疗（共24周）与个性化，辅导员提供的动机和手动认知行为停止治疗。我们假设，延长治疗将优于短期治疗，并且两个治疗组在产生戒烟尝试和最终戒烟方面比常规治疗更有效。次要目标将模拟治疗条件的成本效益;检查治疗结果的调节剂和介导剂;并前瞻性地检查吸烟，心理健康功能和使用其他物质随时间的变化之间的关系。公共卫生相关性声明：在美国，患有精神疾病的人平均提前25年死亡，与烟草有关的心血管疾病、肺病和癌症被确定为主要原因24。尽管吸烟的流行率很高，戒烟率很低，对健康的影响很大，但对吸烟者精神疾病的临床治疗研究仍然有限。本研究的目的是评估，在一项随机对照试验中，不同强度的烟草治疗吸烟者住院的急性精神病住院单位在社区医院。